In Black communities, changing how we treat diabetes is imperative

Perhaps one silver lining of the pandemic is that many Americans finally realize that Donald Trump is not fit to be commander in chief. But even if the president loses in the fall, we cannot allow that to be the only way we improve our nation in response to the pandemic. 
The recent passing of former Rep. John Lewis (D-Ga.) reminds us of the struggle for civil rights in America. But John and I — when we served together in Congress — always believed that we also needed to fight for changes to the quality of life for African Americans.  COVID-19 has brought to light the many disparities in healthcare treatment for Black and brown people in the United States.
One all too common aspect of life for Black people in this nation, regretfully, is diabetes, kidney disease, and the need for dialysis. Dialysis is the process of removing blood from a patient’s body, cleaning it because the kidneys cannot due to loss of function, and returning the blood to circulation.
Shockingly, Blacks suffer from kidney failure at three times the rate than of white folks and, according to the National Kidney Foundation: “African Americans constitute more than 35 percent of all patients in the U.S. receiving dialysis for kidney failure, but only represent 13.2 percent of the overall U.S. population.” Our community’s struggle with diabetes and kidney disease is a stark reminder that we lack the same health outcomes enjoyed by wealthier Americans. They have access to better food options and quality healthcare. 
Now, kidney dialysis in American is big business. Anyone in this country who needs dialysis can get the government to cover those costs. Dialysis is used by about 1 percent of Medicare patients but accounts for 6 percent of Medicare spending.
Today, traveling through any Black neighborhood in America, a local dialysis clinic is always visible. I won’t name the offending companies, but John Oliver, on his show This Week Tonight on HBO, did a wonderful — but depressing —segment about how this industry profiteers and mistreats patients. The owner of one company compares managing a dialysis clinic to running a Taco Bell. I urge you to watch it and not just be outraged but demand improvements.
According to the Centers for Disease Control, those with diabetes and kidney disease are at increased risk of severe illness and even death from Covid-19.  Now more than ever, as we encourage people at high risk to stay home as much as possible, we must change the way we deliver dialysis in America so that patients can remain safe, and not be exposed to the virus to receive dialysis. 
Even without COVID, patients who require treatment at dialysis centers necessarily lead to more restricted lives. They are forced to organize their lives around lengthy clinic visits sometimes multiple times a week.  Many can’t hold jobs, and travel is out of the question. 
In-home dialysis also benefits taxpayers. A typical dialysis patient costs Medicare about $89,000 per year.  In-home dialysis is cheaper, more comfortable, and can be delivered while patients sleep.  Yet amazingly, only 12 percent of American patients receive dialysis this way, compared with  85 percent in Hong Kong and 56 percent in Guatemala.
Thankfully, earlier this year, the Department of Health and Human Services launched a new initiative on renal disease, including pushing for home dialysis and aimed at rewarding better healthcare outcomes rather than the number of treatments.  Andy Slavitt, former director of the Center for Medicare and Medicaid in the Obama administration, calls home dialysis while sleeping the “best standard of care.” I am hopeful that a future Biden administration will pick up the baton on this issue.
So, if we can bring down the cost of dialysis, reduce the dominance of two major providers of outpatient kidney dialysis in the U.S., and improve people’s quality of lives — it would be a sin not to invest further in-home dialysis. This is critical for the Black community. When I chaired the House Oversight and Government Reform Committee, I tried to fight for common-sense changes to federal policies that transform lives. I urge all Americans to demand the government to continue its efforts to improve how we treat kidney patients in this country.

Edolphus Towns runs ET Consulting and is a senior advisor with Gray Global Advisors. He represented both New York’s 10th and 11th congressional districts from 1983-2013 and Chaired the House Oversight and Government Reform Committee during the 111th Congress. 
Tags Detoxification Dialysis Donald Trump John Lewis Liver dialysis Medical specialties National Kidney Foundation

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